Prediktori pobolјšanja kvaliteta života nakon hirurške revskularizacije miokarda su još uvek nepotpuno poznati. Cilj rada je bio da ispita prediktore poboljšanja kvaliteta života šest meseci nakon hirurške revaskularizacije miokarda. Ispitivali smo 208 uzastopnih pacijenata koji su podvrgnuti hirurškoj revaskularizaciji miokarda. Za ispitivanje kvaliteta života korišćen je upitnik Nottingham Health Profile Questionnaire prvi deo. Upitnik se sastoji od 38 pitanja koji su podeljeni u 6 odeljaka: fizička pokretljivost, socijalna izolacija, emocionalne reakcije, energija, bol i san. Upitnik je podeljen svim pacijentima pre i šest meseci nakon operacije. Prosečna starost ispitivanih pacijenata je bila 58,8 ± 8,2 godine, 82% su bili muškarci. Poređenje pre i postoperativnih skorova je pokazalo da se poboljšanje nalazi kod 53,76% bolesnika, pogoršanje kod 12,46%, normalan KŽ pre i posle operacije kod 26,70%, dok je KŽ nakon operacije bez promene kod 7,08% bolesnika. Nezavisni prediktori poboljšanja kod pacijenata nakon operacije su bili: odsustvo prethodnog infarkta miokarda u odeljku fizička pokretljivost (p=0,03; OR=0,59; CI 0,40-0,92), viša CCS klasa angine u odeljcima fizička pokretljivost (p=0,006; OR=2,34; CI 1,46-3,32), energija (p=0,02; OR=1,70; CI 1,29-2,64) i bol (p<0,001; OR=4,64; CI 2,27-7,31), muški pol u odeljku bol (p=0,03; OR=0,45; CI 0,26-0,62) i mlađe starosno doba u odeljku bol (p=0,01; OR=0,69; CI 0,41-0,85). Prediktori poboljšanja kvaliteta života šest meseci nakon hirurške revaskularizacije miokarda su viša CCS klasa angine, odsustvo prethodnog infarkta miokarda, muški pol i mlađe starosno doba.

One of possibilities to estimate size of myocardial injury during the acute myocardial infarction are electrocardiographic changes,
forming of QS formation (ECG signs of scares changes). This investigation which included three groups of patients receiving thrombolytic, nitrates or beta blockers in acute phase of myocardial infarction has aim to analyze 12-chanels electrocardiogram and to establish difference between this therapeutics groups in sum of QRS score, but also to indicateon frequency of periinfarction heart insufficiency in this therapeutics groups, comparing with observed ECG changes. Analysis shows significant differences between groups
in value of QRS score, and also significant lower value of QRS score in patients with acute myocardial infarction treated with thrombolytic therapy. This difference relative to other two groups shows lower level of myocardial injury during acute myocardial infarction in patients treating with thrombolytic therapy. 

U radu je prikazana žena stara 73 godine koja je hospitalizovana u jedinicu Intenzivne nege zbog osećaja nedostatka vazduha i atpičnog diskomfora u grudima unazad dva sata. Krvni pritisak na prijemu je bio veoma povišen (240/130 mmHg), kardijalni troponin i iznad referentnih vrednosti (2,1 ng/ml) a inicijalni EKG zapis bio je sugestibilan za infarkt miokarda bez ST elevacije. Ehokardiografska evaluacija i koronarna arteriografija koje su usledile isključile su akutni koronarni sindrom kao uzrok povećanog kardijalnog troponina.

Pulmonary embolism (PE) and venous thromboembolism are two clinical manifestations of a single entity - venous thromboembolism. PE usually occurs through due thrombi from the lower veins, and in 10-15% of cases are due thrombus from upper veins or right heart failure. Significance is mainly determined by the frequency (1/1000 per year in the adult population; less in younger but significant increase with increasing age), the risk of mortality is important in acute and chronic diseases that are associated with this clinical manifestation. Acute pulmonary embolism is often fatal, with a mean annual mortality of about 30% in untreated. Many deaths occur because of recurrent PE within the first few hours after the initial event. In the nineteenth century, Virchow the mechanism of thromboembolism categorized into three groups: changes in the blood vessel wall, a reduction of blood flow (path) and changes in the composition of the blood (hypercoagulable, prothrombotic). Modern interpretation of the pathogenesis of thromboembolism, which is processed corresponds Virhovljevom concept. In general thromboembolic events can be a result of complications of individual risk factors as increased thrombotic potential.

Insulinska rezistencija je stanje udruženo sa genetskom predispozicijom, sedantarnim načinom života i starenjem. Ono je izazvano i podstaknuto gojaznošću. Metabolički sindrom (MS) pak, predstavlja koincidentno postojanje više metaboličkih poremećaja u čijoj se osnovi nalazi insulinska rezistencija. Cilj ovog rada je bio da se utvrde antropometrijske mere kod obolelih od akutnog infarkta miokarda (AIM) sa i bez metaboličkog sindroma. Prospektivnom studijom obuhvaćeno je 77 bolesnika oba pola koji su lečeni zbog AIM u koronarnoj jedinici Interne klinike-Laplje selo KBC-a Priština sa sedištem u Gračanici. Bolesnici sa reinfarktom miokarda nisu uključivani u istraživanje. Od ukupno 77 ispitanika sa AIM 44 ispitanika je imalo MS ili 57,1% dok je 33 ispitanika bilo bez MS, ili 42.9%. Naše istraživanje je pokazalo sledeće: učestalost MS kod ispitanika lečenih zbog AIM je bila 57,1%; u odnosu na polnu zastupljenost nije nađena bitna razlika između ispitanika sa AIM sa i bez MS ; u grupi ispitanika sa AIM i MS muškarci su bili zastupljeniji (63,6%) u odnosu na žene; nije nađena bitna razlika između poređenih grupa ispitanika u odnosu na starosnu zastupljenost ; poređenjem telesne visine i težine između ispitanika sa AIM sa i bez MS nije nađena značajna razlika ; dobijena je bitna razlika između poređenih grupa ispitanika u odnosu na indeks telesne mase-BMI. Prosečna vrednost BMI kod ispitanika sa AIM i MS je bila 29,34 kg/m2.

U radu je prikazana žena starosti 86 godina kojoj je ehodoplerkardiografskim pregledom postavljena dijagnoza restriktivne kardiomiopatije i dijastolne srčane slabosti zbog prezentovane enormne biatrijalne dilatacije, nedilatirajućih i nehipertrofičnih komora i normalne sistolne funkcije. Zbog starosnog doba nije realizovana endomiokardna biopsija, a prioritetni terapijski cilj je usmeren ka smanjenju Nyha funkcionalne klase.

Acute instable atherosclerotic plate in the basis of the pathophysiology of the acute coronary syndrome and it is divided on two big groups: a) acute coronary syndrome without ST elevation (NONSTEMI) and b) myocardial infarction with ST elevation (STEMI). Clopidogrel belongs to the group of antiaggregation drugs which inhibit ADP receptors and on that way prevent platelets aggregation. The clinical confirmation of the clopidogrel efficiency is confirmed trough 4 big clinical studies: CAPRIE, CURE, COMMIT/CCS 2 and CLARITY-TIMI 28 studies. In CAPRIE study, clopidogrel showed moderate but significant advantage comparing to aspirin in prevention of the secondary ischemic cerebrovascular stroke and myocardial infarction. The results of CURE study showed that doubled combined therapy with clopidogrel and aspirin brought the reduction of the relative risk of cardiovacular events with patients with acute coronary syndrome without ST elevation. The results of this study showed that the group of patients which received clopidogrel beside aspirin and thrombolytic therapy it came to the reduction of the occluded arteries. In COMMIT were also involved the patients with the acute myocardial infarction with ST elevation. Total number of lethal cases of the repeated myocardial infarctions or acute brain stroke was smaller in a group which was receiving clopidogrel beside thrombolytic therapy and aspirine in comparison with the placebo group. The results of CLARITY and COMMIT studies gave us recommendation that patients with acute myocardial infarction with ST elevation which have thrombolytic therapy or percutaneous coronary intervention should receive clopidogrel as well.

In clinical hyperkalemia, correlation between plasma K and the ECG is less reliable. A tall, peaked, symmetrical T wave with a narrow base, the so-called "tented" T wave is the earlinest ECG abnormality, usually best seen in leads II, III, V2, V3, and V4. The tented appearance and the narrow base are probably more characteristic of hyperkalemia than is the amplitude of the T wave. A decrease in amplitude of the R wave, appearance of a prominent S wave, widening of the QRS complex, depression of the ST segment evolve as plasma K approaches 8-9m Eq/liter. With hyperkaliemia, depression of intraventricular conduction is characteristically diffuse and results in prolongation of both the initial and terminal parts of the QRS complex. The resulting pattern may resemble RBBB, LBBB, left anterior or posterior divisional block, or a combination of the four.

Metformin is an anti-hyperglycemic agent used for the treatment of type 2 diabetes mellitus. Biguanides lower blood glucose levels primarily by decreasing the amount of glucose produced by the liver. Metformin also helps to lower blood glucose levels by making muscle tissue more sensitive to insulin so glucose can be absorbe. The purpose of the study was to establish the effect of metformin on insulin secretion in obese patients with newly diagnosed diabetes mellitus type 2. We included 40 patients with Type-2 Diabetes Mellitus, who were treated on Department for Internal Disease in Hospital King Milutin Laplje Selo. Patients included in the study were newly diagnosed with diabetes mellitus type 2, glycemia < 12 mmol/L, and hed the Body Mass Index >30 kg/m2. They were treated with metformin, 1000 mg/day. Insulin sensitivity was determined by HOMA IR, insulin secretion by HOMA, lipid status by spectrophotometry. After six months of treatment blood biochemistry tested again. BMI was also established. Metformin significantly lowered BMI (BMI before therapy 31.02 kg/m2, after treatment 28.7 kg/m2) (both p<0,001 vs baseline) waist circumference mean value 98±0.55 cm-93,12 cm. (p<0,001) During the therapy the glycaemia decreased from 11.7 mmol - 6,78 mmol/l, insulinemia mean value 20.141 mlU/l -13.691, HOMA IR elevated in all patients. Among the cholesterol fractions, most significant results were obtained in LDL cholesterol. Mean LDL cholesterol levels 4.51± 2.02 mmol/L. Mean cholesterol level 6.98±2.31 mmol/L. HDL levels -1.32 mmol/L. Serum triglycerides was (mean) 2.63±1.32mmol/L. After six months therapy Metformin produces beneficial changes in lipid states. Metformin may be the first therapeutic option in the diabetes mellitus type 2 with overweight or obesity. Metformin produces beneficial changes in glycemia control, and moderated in weight, lipids and insulinemia. 

The existence of left ventricular hypertrophy is an independent prognostic factor for cardiovascular morbidity and mortality. Heterogenous factors lead to left myocardial hypertrophy. The most frequently factors are: arterial hypertension, valvular heart disease (aortic stenosis and insufficiency, mitral insufficiency), hypertrophic myocardiopathy, left myocardial hypertrophy after myocardial infarction... For making the diagnosis of left ventricular myocardial hypertrophy used electrocardiography („voltage“ and „repolarization“ criteria) and echocardiography. Echocardiography is the gold standard for diagnosis of left ventricular myocardial hypertrophy. Left ventricular mass was estimated by the modified formula 3 3 using measurements obtained in accordance with the Penn convention: MLK = 1,04 (LDDd+PWDd+IVSDd) - (LVDd) - 13,6 Where LDDd is diastolic left ventricular internal dimension, IVSDd is diastolic ventricular septal thickness and PWDd 2 is diastolic posterior left ventricular wall thickness in diastole. LV mass indexed by body surface area (g/m ). By Penn con2 2 vention left ventricular hypertrophy criteria were ≥134 g/m for men and ≥110 g/m for women.